Public Health Care Enemy Number 1: Childhood Obesity

This is part one of a two-part series. The first part addresses the scope and implications of childhood obesity; the second will focus on solutions and their implementation.

Dr. Robert Murray is not the kind of person given to exaggeration or hyperbole. So when he states that from a public health perspective, no issue is more important than the future implications of obesity among children, we need to listen. And then act. In his view, "we can't afford to do nothing."

Dr. Murray is well qualified to draw this conclusion based on his role as chair of the American Academy of Pediatrics Council on School Health and advisor to the national Action for Healthy Kids initiative, a program designed to promote school policies that combat obesity. He is also the director of the Center for Healthy Weight and Nutrition at Nationwide Children's Hospital and professor of clinical pediatrics at the Ohio State University College of Medicine.

In an effort to understand the magnitude and scope of obesity among children, I asked Dr. Murray the following questions. His responses follow.

1. How many children are obese in the United States? What is the trend?

National trends show that rates of overweight (above the 85th percentile for body mass index, BMI) and obesity (above the 95th percentile BMI) among children and teens rose steadily from the mid-1970s until 2003. Currently, 32 percent of kids and teens from 6 to 19 years of age are overweight and 17 percent are obese.

The most disturbing trend is with the two to five-year-old group. In the 1970s, obesity rates were less than five percent for this group. By the 1990s, rates had doubled, but there is wide variability among ethnic subpopulations. For Caucasian children two to five years old, the obesity rate is 8.5 percent; for Mexican American children, 10.8 percent; and for African American children, 13.4 percent.

Although urban, ethnic impoverished kids fit the profile for highest risk of obesity and its complications, studies by the Ohio Department of Health on third graders across the state show that many rural counties have rates similar to those of large urban communities. In one BMI screening in Columbus public schools, 40 percent of the third graders were overweight, and by middle and high school, 50 percent.

Equally troublesome, although those with extreme obesity make up a smaller percentage of the population, this group is growing at the fastest rate. Obesity-related chronic diseases (high cholesterol or other abnormal lipids, hypertension, sleep apnea, polycystic ovary syndrome and liver disease) are very common among these individuals.

2. What are the costs children pay for being overweight?

Two very important problems arise for young children with obesity. One is that they can't keep up with their peers during activities or sports. The second is that they are treated differently by their classmates and by adults.

The negative bias against overweight begins early. Children as young as five years can perceive the bias. In school, bullying is common, adding to overweight children's sense of alienation and loneliness. Obese children have high rates of depression. In studies of their quality of life, obese children scored similarly to children with cancer. Also, children and teens with obesity have greater missed days of school and poorer school performance based on grades, successful graduation and nationalized test scores.

If children with obesity remain untreated, not only do the vast majority become obese adults, but also they begin to develop chronic diseases that further diminish their quality of life. Obese adults are less likely to be hired, are less likely to be advanced at work and are perceived as less productive than their normal-weight counterparts, illustrating the pervasive bias against them in American society. So for the obese, the marginalization begins as soon as they start school and never lets up throughout their life. Obesity is one of the most burdensome chronic diseases an individual can have--emotionally, psychologically and medically.

3. What are the future implications for the health of these children?

The long-term consequences of obesity are nearly all targeted at the cardiovascular system and result in a high risk of heart attack and stroke. In addition, inflammation of the liver is becoming one of the leading causes of liver failure and need for a transplant. Cancer deaths are heightened by obesity. Orthopedic problems are greatly amplified by excess weight, especially low back, hip, knee, ankle and foot injuries. In fact, injuries in general are higher among the obese. Sleep apnea is both the result of and the cause of excess weight, a vicious cycle of problems caused by abnormal brain chemistry in the feeding and satiety centers of the brain (the hypothalamus).

Childhood obesity should be considered a serious medical problem. Every effort should be made to identify obese children through screening and through awareness of their family's health history for obesity, heart disease and diabetes. The primary care physician is the key to prevention and early recognition and treatment. Unfortunately, the word "obesity," carrying tremendous negative baggage, prevents the community, parents and clinicians from seeing the serious risk of chronic disease behind the obesity. This has to change if we are going to control this public health problem.

But who can orchestrate the changes we need? Do we need to understand the causes before applying the remedies? And what do we know about remedies that are currently working, ones that fitness advocates can replicate in their own communities? Dr. Murray addresses these questions in part two.